Effects of an estrogen-free, desogestrel-containing oral contraceptive in women with migraine with aura: a prospective diary-based pilot study

Background: Migraine with aura (MA) is a contraindication to the use of combined oral contraceptives (COCs) because of the increased risk of ischemic stroke. Progestogen-only contraceptive pill (POP) is a safe alternative to COCs and it is preferable in women with cerebrovascular diseases or risk factors for stroke. Study Design: Prospective diary-based pilot study. Thirty women with MA (n=15 who have never used COCs and n=15 who had previously used COCs were diagnosed according to the International Headache Society criteria. The observational period lasted 9 months during which women filled in a diary with the clinical characteristics of headache attacks. After a 3-month run-in period, each subject received an estrogen-free desogestrel (DSG) (75 mcg/day)-containing OC (Cerazette (R); Schering-Plough, formerly NV Organon, Oss, The Netherlands). Followup evaluations were planned at the end of the third and sixth month of treatment. Results: The number (mean+/-S.D.) of migraine attacks was significantly reduced both in previous COCs users (from 3.9+/-1.0 to 2.9+/-0.8; p<.001) and nonusers (from 3.2+/-0.9 to 2.6+/-1.3; p<.02) following 6 months of POP use in comparison with the run-in period. Duration of headache pain did not differ significantly in both groups throughout the study. Interestingly enough, a beneficial POP effect on the duration (mean S.D.) of visual aura (from 16.3+/-9.5 to 11.4+/-5.6 min) and on the total duration (mean+/-S.D.) of neurological symptoms (from 33.6+/-23.3 to 18.6+/-18.0 min) was only significantly reported by previous COCs users (p<.001, for both) by the end of the study period. The POP was well tolerated by each woman and the bleeding pattern was variable with a tendency towards infrequent bleeding. Conclusions: The present study supports the use of the POP containing desogestrel in a population of women with MA and underlines a positive effect on symptoms of aura, especially in MA sensitive to previous use of COCs. (C) 2011 Elsevier Inc. All rights reserved.